Hurricane-related maternal stress, infant outcomes and resilience factors

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Abstract: For many Puerto Ricans, what happened on September 20th, 2017 was similar to having a nuclear bomb attack as seen on Hollywood movies. In fact, this is might have been close to what happened. During its life cycle, an average Hurricane can expend as much energy as 10,000 nuclear bombs as calculated by NASA. As of March 2018, almost 6 months’ post Hurricane Maria, the Government of PR has calculated that 100,000 households are still lacking power. The impact of this catastrophe includes the 20 hours or so of experiencing heavy winds, noise, darkness and fear for life and property, but the initial weeks of lack of power and communications, interrupted services, scarcity of fuel, dark and empty streets, need for cash for every transaction followed by months of slow recovery. The population endured the initial disruption with the hope of quick restoration of services which transformed to frustration and anger. In this context, pregnant women experienced disruption of prenatal care and monitoring, regardless of the trimester. We believe this extension of months without normality, added to maternal stressors, impacted care and services and might affect other children’s outcomes in the future. Adverse infant outcomes might have been caused by elevated levels of in utero maternal stress, post-natal maternal stress with lack of adequate nutrition or sanitary conditions, lack of proper pediatric preventive and acute care in the immediate aftermath, decreased compliance with pediatric care due to lack of infrastructure, transportation, competing priorities and overwhelming of families. Family support might have played an important role in buffering the impact and adverse consequences or in a more active role supporting resiliency. The impact of this Hurricane will have long-lasting consequences if we do not develop interventions appropriate for specific groups and communities. This is a mixed methods study with the following aims: 1. To compare the impact of a catastrophe (Hurricane Maria and its aftermath) on the well- being of mothers and children with different timing exposure to the event: exposed during pregnancy vs. recent motherhood for women; in-utero vs post-natal for infants; 2.To explore (with in-depth interviews) the impact, personal meaning and sense-making by mothers during and after the Hurricane regarding access (or lack of) to health care, medical and social services and diverse support systems, including family and community, for both groups of mothers and 3. To identify specific resilience factors that would have ameliorated the adverse effects observed as a consequence of Hurricane-related stressful experiences on the maternal and infant health of this population and that can inform culturally sensitive interventions post disaster.